Florida fines Humana $3.4 million for slow reports of suspected fraud

Humana is the state's largest, most profitable HMO

The state has fined health insurance giant Humana Inc. $3.4 million for failing to promptly report Medicaid fraud or abuse to state investigators, as the law requires.

The company did not disclose what it knew about suspected fraud and abuse by Medicaid providers — such as doctors and hospitals — or recipients back as far as Sept. 1, 2009, health regulators said in two letters sent last week to Humana's Miramar office.

Humana and its CarePlus subsidiary together make up Florida's largest and most profitable HMO with 568,000 members — most of them in Medicare — and 2010 profits of $330 million. Nationwide, the company is the second-largest Medicare insurer, with 4.3 million members.

It's unclear if the fine is related to an internal investigation the company is making in South Florida, which the company says it has disclosed to federal prosecutors, Medicare and state Medicaid officials.

The investigation is looking into potentially improper loans or financial assistance the company made to Florida providers, including physician groups, and improper relationships between company employees and providers, the company said in public documents filed in May.

Last week's letters from Mike Blackburn, chief Medicaid inspector general at Florida's Agency for Health Care Administration, did not specify what instances of fraud or abuse the company failed to promptly disclose. Agency officials were not available for comment.

Humana's Florida spokesman Mitchell Lubitz said the company is reviewing the letters and "after completing the review, Humana will determine its next steps, including whether to appeal the fine."

The company declined to comment on the internal investigation.

The letters said the state fined the company $2.7 million — at $1,000 a day per violation — for not disclosing fraud or abuse as the law requires Medicaid HMOs to do within 15 days of discovering it.

A second fine of $660,000 — at $200 a day — says the company's failure to disclose the fraud violates the terms of its contract as a Medicaid HMO.